| NPI | 1063835304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101038226) |
| Additional Taxonomies | 207RI0200X Internal Medicine Infectious Disease (Licence: VA 0101038226) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2014-01-22 |