| NPI | 1285077511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE 28135) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 28135) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2022-10-06 |