| NPI | 1255727756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AR E-15510) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 308674) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2022-09-22 |