| NPI | 1073018750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 238483) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 238483) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2021-08-13 |