| NPI | 1023471521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics (Licence: NC 2022-02211) |
| Additional Taxonomies | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: OH 35.136209) |
| 208000000X Pediatrics (Licence: OH 35.136209) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2024-03-05 |