| NPI | 1164885125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: OH 35.145111) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.145111) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: KY 57544) | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2024-12-18 |