| NPI | 1477892032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 281479) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101256748) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-02-01 |
| Last Update Date | 2020-10-07 |