NPI | 1114362621 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: MD D81432) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD P-625-603-734-927) |
Enumeration Date | 2013-05-10 |
Last Update Date | 2024-11-01 |