| NPI | 1932423993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DC 249011) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 35000705) |
| Enumeration Date | 2010-03-19 |
| Last Update Date | 2015-06-13 |