| NPI | 1215496252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D0093606) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD 5319) |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2022-09-14 |