NPI | 1710249883 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD455759) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT200901) |
Enumeration Date | 2012-06-13 |
Last Update Date | 2016-03-29 |