| NPI | 1083077424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 88567) |
| 208000000X Pediatrics (Licence: AL MD.36233) | |
| 208000000X Pediatrics (Licence: GA 88567) | |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2022-06-20 |