| NPI | 1942209796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.069275) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 01057971A) |
| 208000000X Pediatrics (Licence: PA MD444948) | |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2022-10-13 |