| NPI | 1124021258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0208X Pediatrics, Pediatric Infectious Diseases (Licence: TN 57382) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 38376) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2021-11-17 |