| NPI | 1063161909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: AZ 011534) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2022-03-19 |
| Last Update Date | 2025-05-21 |