| NPI | 1922549187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 35.138672) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 35.138672) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2020-06-03 |