| NPI | 1942247432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.155645) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301070674) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2026-04-08 |