| NPI | 1730123852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: OH 35077182) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: OH 35077182) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: KY 46953) | |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: KY 49653) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2017-03-30 |