| NPI | 1104455203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD215473) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO DR.0073197) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2024-09-18 |