| NPI | 1306136577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE 1011) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 1011) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2023-07-07 |