| NPI | 1437333770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2009-01043) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 135599) |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2023-10-16 |