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 |