| 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 |