| NPI | 1770926289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 70759) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2016-00655) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2024-07-18 |