| NPI | 1215386115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301508144) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301508144) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301109967) | |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2022-12-14 |