| NPI | 1649441346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D84064) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 259251) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-03-20 |
| Last Update Date | 2017-10-04 |