| NPI | 1346829934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AR E-19232) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 99405) |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2025-06-23 |