| NPI | 1275894255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 66163) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301100893) |
| 208000000X Pediatrics (Licence: MI 4301100893) | |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2020-10-09 |