| NPI | 1073010799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 19098) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207K00000X Allergy & Immunology (Licence: CA 19098) | |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2023-02-15 |