| NPI | 1235699539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2022-00653) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: FL UO6449) | |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2023-10-21 |