| NPI | 1376572107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: OH 35-082466) |
| Additional Taxonomies | 2080H0002X (Licence: OH 35082466) |
| 207R00000X Internal Medicine (Licence: OH 35-082466) | |
| 208000000X Pediatrics (Licence: OH 35082466) | |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2024-08-16 |