| NPI | 1982098273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX R7433) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 1982098273) |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2019-01-09 |