| NPI | 1669521332 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00026233)  | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 01034261A)  | 
| Enumeration Date | 2007-01-10 | 
| Last Update Date | 2025-09-11 |