| NPI | 1508113390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A139753) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 14100) |
| Enumeration Date | 2012-08-10 |
| Last Update Date | 2022-07-21 |