| NPI | 1225665763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI EMC0009197) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX V3211) |
| 208000000X Pediatrics (Licence: FL ME179492) | |
| 208000000X Pediatrics (Licence: TN 67993) | |
| 208000000X Pediatrics (Licence: GA 98574) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208000000X Pediatrics (Licence: NC 202600205) | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2026-06-04 |