| 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 |