| NPI | 1942403654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: CA A125815) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A125815) |
| 208000000X Pediatrics (Licence: MA 242593) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 242593) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301090194) | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2021-12-02 |