| NPI | 1922309343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080H0002X (Licence: SC 51359) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 71879) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-11-17 |
| Last Update Date | 2022-07-21 |