| NPI | 1609191345 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WI 56784) | 
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: IL 036.143459) | 
| Enumeration Date | 2010-04-06 | 
| Last Update Date | 2025-07-07 |