| NPI | 1720045974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 35.093245) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 250853) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2015-06-25 |