| NPI | 1780970020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE 27919) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 2011017314) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2023-04-21 |