| NPI | 1093178915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AR E-12104) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 82349) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2025-08-08 |