| NPI | 1124318241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX W2358) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036136838) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-10 |
| Last Update Date | 2025-12-15 |