| NPI | 1851588644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ID M-8153) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101264959) |
| 208000000X Pediatrics (Licence: UT 5053872-1205) | |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2022-01-12 |