| NPI | 1891981825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 55675) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 55675) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2018-07-03 |