| NPI | 1912998352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 35069494) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35069494p) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2022-02-12 |