| NPI | 1073950812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: HI DOS-1653) |
| Additional Taxonomies | 208D00000X General Practice (Licence: HI DOS-1653) |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2025-04-22 |