| NPI | 1104322767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MS T-3682) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2019-07-17 |