| NPI | 1639599368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.132997) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 61057) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 35.132997) | |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2021-07-07 |