| NPI | 1669478459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: OH 35079310) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35079310) |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: OH 35079310) | |
| Enumeration Date | 2005-06-26 |
| Last Update Date | 2021-05-26 |