| NPI | 1912992678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AL 32891) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 40582) |
| 208000000X Pediatrics (Licence: TN MD30442) | |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2022-07-21 |