| NPI | 1902192966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 074002) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 5030) |
| 208000000X Pediatrics (Licence: TN MD51295) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2015-11-17 |