| NPI | 1891445938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.152642) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 60537) |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2026-05-27 |