| NPI | 1578524500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01050472) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 34240) |
| 208000000X Pediatrics (Licence: KY 34240) | |
| 208000000X Pediatrics (Licence: IN 01050472) | |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2009-11-17 |