| 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 |