| NPI | 1902210404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.151519) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 29116) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2024-11-11 |