| NPI | 1154908630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 83605-20) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 72289) |
| 208000000X Pediatrics (Licence: MN 31620) | |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WI 8360520) | |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2025-09-09 |