| NPI | 1003618950 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-12381) |
| Enumeration Date | 2025-03-24 |
| Last Update Date | 2025-06-17 |