| NPI | 1235297847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 12315) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 12315) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2024-06-05 |