| NPI | 1427492800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 65402) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101263390) |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2022-07-20 |