| NPI | 1063726420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: TX P6739) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036.125815) |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2022-10-25 |