| NPI | 1447411962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2011-01045) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 149458) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2012-07-17 |