| NPI | 1215558424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MT220456) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD479350) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208000000X Pediatrics (Licence: MO 2023010935) | |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2023-06-07 |