| NPI | 1336554310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101259394) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 31-0672132) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2022-01-18 |