| NPI | 1598958605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.093513) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 093513) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2024-07-24 |