| NPI | 1710325402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A171215) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 11017206A) |
| 208000000X Pediatrics (Licence: IN 11017206A) | |
| 208000000X Pediatrics (Licence: CA A171215) | |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2021-12-09 |