| NPI | 1194985606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 270683) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NY 270683) | |
| 208000000X Pediatrics (Licence: DC MD037582) | |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2013-10-17 |