| NPI | 1487974747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL OS9823) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO2435) |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2024-06-10 |