| NPI | 1134562127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD70101958) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A135479) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2026-04-06 |