| NPI | 1326274929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 54572) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 31732) |
| 208000000X Pediatrics (Licence: KY 46043) | |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2024-01-18 |