| NPI | 1871624940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 54268) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00048269) |
| 208000000X Pediatrics (Licence: CT 039470) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2022-03-18 |