| NPI | 1669760500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX S3351) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DE C10011019) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2019-09-20 |