| NPI | 1033963327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0116039710) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116039710) |
| 207R00000X Internal Medicine (Licence: DC MTL500002638) | |
| 208000000X Pediatrics (Licence: DC MTL500002638) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-04-15 |
| Last Update Date | 2024-06-11 |