| NPI | 1700203809 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35-127410) | 
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 35-127410) | 
| 208M00000X Hospitalist (Licence: OH 35127410) | |
| Enumeration Date | 2014-03-26 | 
| Last Update Date | 2025-05-19 |