| NPI | 1972948842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080H0002X (Licence: GA 78281) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 78281) |
| 208000000X Pediatrics (Licence: DC MD044052) | |
| 208000000X Pediatrics (Licence: GA 78281) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2022-06-22 |