| NPI | 1194475459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 74726) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 32622) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2023-07-11 |