| NPI | 1740481415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301100285) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2010-01355) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 141520) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2016-10-07 |