| NPI | 1588654735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 35.135256) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME127537) |
| 208000000X Pediatrics (Licence: KY 39337) | |
| 208000000X Pediatrics (Licence: OH 35.135256) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NC 2019-02646) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: KY 39337) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2025-08-29 |