| NPI | 1912494873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A195490) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 30293) |
| 208000000X Pediatrics (Licence: OH 35.141244) | |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2024-08-22 |