| NPI | 1538379326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60088380) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.092850) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57011966) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2021-05-25 |