NPI | 1063146793 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10091552) |
Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101284790) |
Enumeration Date | 2022-07-09 |
Last Update Date | 2025-06-24 |