| NPI | 1356752638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 5101021012) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101021012) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101021012) | |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2021-07-14 |