| NPI | 1770164055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 35.149663) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.149663) |
| Enumeration Date | 2021-04-18 |
| Last Update Date | 2025-09-12 |