| NPI | 1699074484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 207454) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 258100) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-20 |
| Last Update Date | 2021-03-31 |