| NPI | 1164673232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101248556) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 62234) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2024-11-04 |