| NPI | 1063708774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2015-0749) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01075523A) |
| 208000000X Pediatrics (Licence: IN 01075523A) | |
| 208000000X Pediatrics (Licence: NM MD2015-0749) | |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2015-10-07 |