| NPI | 1821595919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: OH 35.155713) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 55217) |
| 208000000X Pediatrics (Licence: OH 35.155713) | |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2026-09-16 |