NPI | 1518386556 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: MD D85060) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
208000000X Pediatrics (Licence: VA 0101262373) | |
Enumeration Date | 2014-04-07 |
Last Update Date | 2024-09-09 |