| NPI | 1730566696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036148949) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN MD0000057365) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2019-06-29 |