| NPI | 1720279060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A105486) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MP 516) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2015-02-03 |