| NPI | 1942521232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A127341) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY Do not have one yet) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2021-12-17 |