| NPI | 1922038348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: OK 30099) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: OH 35088035) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2013-10-24 |