| NPI | 1831177120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 34285) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35075474) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: OH 35075474A) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: KY 34285) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: KY 34285) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2023-06-20 |