| 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 |