| NPI | 1194351155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A182640) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036.164592) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-20 |
| Last Update Date | 2024-12-11 |