| NPI | 1578701710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P9300) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: FL ME105496) | |
| Enumeration Date | 2009-01-26 |
| Last Update Date | 2015-05-20 |