| NPI | 1790028850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DC MD047440) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX R6419) |
| 208000000X Pediatrics (Licence: VA 0101260177) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2021-10-20 |