| NPI | 1275876559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NM MD2016-0491) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM 1275876559) |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2017-02-15 |