| NPI | 1134395114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2009-01088) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 134702) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2024-02-08 |