| NPI | 1952374803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301095482) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35077321) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2011-06-30 |