| NPI | 1104494798 |
|---|---|
| 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: MO 2022039727) |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2024-04-10 |