| NPI | 1497082648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0210X Pediatrics, Pediatric Nephrology (Licence: CT 54561) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 255221) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-11-09 |
| Last Update Date | 2016-07-18 |