| NPI | 1972602902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AL 33419) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY TP873) |
| 208000000X Pediatrics (Licence: TN 20926) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2020-05-04 |