| NPI | 1912094046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 68374) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN MD38869) |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2019-09-30 |