| NPI | 1255531158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 29916) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35131169) |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: OH 35131169) | |
| 208M00000X Hospitalist (Licence: OH 35131169) | |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2019-08-08 |