| NPI | 1851580880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AL 28821) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN8944) |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2011-03-01 |