| NPI | 1821293416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: HI 14856) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: HI MD 14856) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2024-03-26 |