| NPI | 1275732372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C152209) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 01067951A) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2020-11-08 |