NPI | 1083974174 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: MN 59832) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KS 94-07875) |
Enumeration Date | 2012-05-22 |
Last Update Date | 2024-08-07 |