| NPI | 1750347712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: OH 35.045477) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35045477) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2025-01-24 |