| NPI | 1104061704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 336.097347) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 01089105A) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: IN 01089105A) | |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2023-10-23 |