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 |