| NPI | 1932461803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0208X Pediatrics, Pediatric Infectious Diseases (Licence: NY 316841) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125061204) |
| 208000000X Pediatrics (Licence: CA A142695) | |
| 208000000X Pediatrics (Licence: IL 125061204) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 316841) | |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2023-07-17 |