| NPI | 1013538305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 20A21203) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA OT020444) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2023-06-22 |