| NPI | 1619955192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.089012) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM 2004-0547) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NM 2004-0547) | |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2020-11-25 |