| NPI | 1780848820 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 51829) |
| Additional Taxonomies | 2080P0208X Pediatrics, Pediatric Infectious Diseases (Licence: KY 51829) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2018-10-18 |