| NPI | 1992173041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: OH 35.128709) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX R8854) |
| 208000000X Pediatrics (Licence: ME MD21890) | |
| 208000000X Pediatrics (Licence: OH 35.128709) | |
| Enumeration Date | 2015-09-07 |
| Last Update Date | 2024-06-07 |