| NPI | 1407396328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 35.146471) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.146471) |
| Enumeration Date | 2017-02-24 |
| Last Update Date | 2025-09-08 |