| NPI | 1497376123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0208X Pediatrics, Pediatric Infectious Diseases (Licence: VA 0101273150) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 208000000X Pediatrics (Licence: VA 0101273150) | |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2026-08-12 |