| NPI | 1780658997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 35092298) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 41344) |
| 208000000X Pediatrics (Licence: OH 35092298) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2022-02-14 |