| NPI | 1891790804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.056893) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35-05-6893-G) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2013-01-31 |