| NPI | 1306958459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 41259) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 01057050A) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-05-01 |