| NPI | 1417302126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 036.152433) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036.152433) |
| Enumeration Date | 2016-05-01 |
| Last Update Date | 2020-05-20 |