| NPI | 1629042379 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: MO 2011016078)  | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2011016078)  | 
| Enumeration Date | 2006-02-16 | 
| Last Update Date | 2025-04-17 |