| NPI | 1780962845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IA MD-43417) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ND PT13160) |
| 208000000X Pediatrics (Licence: ND 13160) | |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2016-07-21 |