| NPI | 1225032147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH OH35074948O) |
| Additional Taxonomies | 207RA0401X Internal Medicine Addiction Medicine (Licence: OH 35074948) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2021-02-24 |