| NPI | 1720428915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2019039182) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DE C10011752) |
| 208D00000X General Practice (Licence: DE C10011752) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2020-11-03 |