| NPI | 1639556871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME136813) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 01086541A) |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2023-04-04 |