| NPI | 1730476425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ND 15701) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301098597) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301098597) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2023-07-25 |