| NPI | 1639387178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 55688) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 36186) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116018224) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2022-07-21 |