| NPI | 1881988954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: OH 35.123633) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL33600) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2022-07-21 |