| NPI | 1245817634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX V1271) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD 6928) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD 6928) | |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2024-12-31 |