| NPI | 1629502265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ID M-17696) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 60530) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2024-04-23 |