| NPI | 1144530965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2020016140) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301096354) |
| 208000000X Pediatrics (Licence: MA 255432) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101261798) | |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2020-08-21 |