| NPI | 1841638004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IN 0470289002) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.135392) |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2026-05-13 |