| NPI | 1366821746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 04534) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 02006228A) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2021-01-07 |