| NPI | 1063745644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 267662) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D0090694) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2021-04-20 |