| NPI | 1245689413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PR 21436) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 32856-R) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 32267-R) | |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2020-10-22 |