| NPI | 1184774093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA 324268) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 01056759A) |
| 208000000X Pediatrics (Licence: NC 2011-01514) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2020-12-29 |