| NPI | 1487911095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101264322) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 52671) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2018-08-07 |