| NPI | 1770617029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 5101016254) |
| Additional Taxonomies | 2080P0205X Pediatrics, Pediatric Endocrinology (Licence: OH 34-009077) |
| 208D00000X General Practice (Licence: OH 34.009077) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101016254) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2021-06-02 |