| NPI | 1396168183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MT215416) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 25794373) |
| Enumeration Date | 2014-01-29 |
| Last Update Date | 2018-06-12 |