| NPI | 1912272014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080H0002X (Licence: ID m15265) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: WA ml60292919) | |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2020-07-02 |