| NPI | 1134614985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ID O-1828) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-10323) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2023-06-08 |