| NPI | 1184001042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AK 197005) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 10094291-1205) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2024-03-21 |