| NPI | 1992701965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TN MD0006575) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: TN MD006575) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2014-10-13 |