| NPI | 1649633819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0208X Pediatrics, Pediatric Infectious Diseases (Licence: PA MT210405) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD466465) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2023-05-09 |