| NPI | 1396130571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX S3608) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ME MD22710) |
| 208000000X Pediatrics (Licence: NV 18398) | |
| 208000000X Pediatrics (Licence: AZ 57640) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2021-02-28 |