| NPI | 1932312568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AL MD.29029) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.010550) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2008-07-29 |