| NPI | 1477841633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IN 01072955A) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: MI 4301099117) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2023-11-27 |