| NPI | 1437192622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX M4694) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 01054292A) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2012-07-25 |