| NPI | 1548217250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: OH 35038694) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35038694) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2012-12-03 |