| NPI | 1629399019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0208X Pediatrics Pediatric Infectious Diseases (Licence: TN MD0000052589) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A112830) |
| Enumeration Date | 2010-06-20 |
| Last Update Date | 2015-10-12 |