| NPI | 1114403151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WY 16979A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 20180119719) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2024-10-16 |