| NPI | 1982223186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301510360) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.148245) |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2023-09-05 |