| NPI | 1932543881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WY 12335A) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA C169933) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2020-10-14 |