| NPI | 1396194387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: DC MD047012) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT211427) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2019-09-17 |