| NPI | 1972746568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0210X Pediatrics, Pediatric Nephrology (Licence: MN 64595) |
| Additional Taxonomies | 2080P0210X Pediatrics, Pediatric Nephrology (Licence: OH 35.126953) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-04-12 |
| Last Update Date | 2018-09-18 |