| NPI | 1447542949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NE 27170) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 27170) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2022-07-21 |