NPI | 1902168537 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: TN 52834) |
Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL34830) |
Enumeration Date | 2012-06-11 |
Last Update Date | 2024-01-29 |