| NPI | 1841695095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NC 2020-00938) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: OH 57.030437) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2024-02-13 |