| NPI | 1972824720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN MD49987) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 4148) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2025-11-17 |