| NPI | 1720423411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: KY TP909) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 129232) |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: OH 129232) | |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2022-06-09 |