| NPI | 1083119077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0208X Pediatrics, Pediatric Infectious Diseases (Licence: MO 2021024630) |
| Additional Taxonomies | 2080P0208X Pediatrics, Pediatric Infectious Diseases (Licence: KS 05-49242) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2025-12-01 |