| NPI | 1629331699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 26907) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME120002) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 26907) | |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2024-09-03 |