| NPI | 1811902307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX M4774) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 052430) |
| 2080P0208X Pediatrics, Pediatric Infectious Diseases (Licence: TX M4774) | |
| 208000000X Pediatrics (Licence: MI 4301076996) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2024-08-15 |