| NPI | 1790893741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AR E-14871) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 13780) |
| 208000000X Pediatrics (Licence: OK 26715) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2021-11-30 |