| NPI | 1245817634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD 6928) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD 6928) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2023-02-15 |