| NPI | 1306250246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A179522) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01076206A) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2022-10-25 |