| NPI | 1134513195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 63612) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.133076) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2021-06-22 |