| NPI | 1043673270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: OH 35.142890) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA A161467) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: MD D99006) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MD D99006) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: OH 35.142890) | |
| 2251P0200X Physical Therapist, Pediatrics (Licence: MD D99006) | |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2024-01-24 |