| NPI | 1669903381 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036-172456) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35139442) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 35139442) | |
| 208000000X Pediatrics (Licence: WI 5027) | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2025-01-28 |