| NPI | 1205321205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0208X Pediatrics, Pediatric Infectious Diseases (Licence: KY 60239) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.144506) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2025-07-31 |