| NPI | 1619167228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 34011961) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 34011961) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2025-12-02 |