| NPI | 1902036767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: OH 35.126221) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT194538) |
| 208000000X Pediatrics (Licence: WI 56734) | |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2021-11-16 |