| NPI | 1053867648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2080P0214X Pediatrics, Pediatric Pulmonology (Licence: CT 80651) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2025-07-31 |