NPI | 1386064285 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: UT 10493833-1204) |
Additional Taxonomies | 208000000X Pediatrics (Licence: KS 98-08403) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2014-04-18 |
Last Update Date | 2023-03-28 |