NPI | 1154775351 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.138887) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.138887) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-04-14 |
Last Update Date | 2022-12-01 |