| NPI | 1487615415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01049550A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 32440) |
| 208000000X Pediatrics (Licence: KY 32440) | |
| 208000000X Pediatrics (Licence: IN 01049550A) | |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2015-03-30 |