| NPI | 1184803827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 3735321205) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 127935) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2011-10-05 |