NPI | 1972627701 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301083472) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301083472) |
Enumeration Date | 2007-03-19 |
Last Update Date | 2021-06-18 |