| NPI | 1427390863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA GA88015) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 300784) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208000000X Pediatrics (Licence: MA 278544) | |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2021-06-17 |