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 |