| NPI | 1043552706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 54746) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NV LL2445) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208000000X Pediatrics (Licence: TN 69601) | |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2023-10-19 |