| NPI | 1376707273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AL 31134) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301092157) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301092157) | |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2023-12-13 |