| NPI | 1508075078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D72316) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116018318) |
| 208M00000X Hospitalist (Licence: MD D72316) | |
| 208000000X Pediatrics (Licence: VA 0101245468) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2018-06-25 |