| NPI | 1235668377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101272568) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD470758) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT213286) | |
| Enumeration Date | 2017-06-11 |
| Last Update Date | 2022-08-24 |