| NPI | 1972583367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 32583) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 01060811A) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2021-02-15 |