| NPI | 1174936207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV DO2818) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA OP60666398) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2023-03-16 |