| NPI | 1649569609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080H0002X (Licence: KY 49833) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 49833) |
| 208000000X Pediatrics (Licence: IN 01078113A) | |
| 2080H0002X (Licence: IN 01078113A) | |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2025-01-08 |