| NPI | 1912281056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 50654) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 29060) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.055878) | |
| Enumeration Date | 2011-10-07 |
| Last Update Date | 2023-06-23 |