| NPI | 1134380074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA OS019565) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0102202563) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2023-03-20 |