| NPI | 1205121118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 2921) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA OT014062) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2025-12-18 |