| NPI | 1538435359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 14184163-1204) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 20A13883) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208000000X Pediatrics (Licence: ID O-1157) | |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2025-04-09 |