| NPI | 1972673143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: OH 35.084117) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35084117) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2022-02-14 |