| NPI | 1346277845 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.073457)  | 
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 35.073457)  | 
| Enumeration Date | 2006-06-28 | 
| Last Update Date | 2015-12-28 |