| NPI | 1689938979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0208X Pediatrics, Pediatric Infectious Diseases (Licence: UT 14270697-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL34998) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2026-04-03 |