| NPI | 1104052497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: HI MD-16650) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: HI MDR-5704) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2018-03-20 |