| NPI | 1265292270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2025018720) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-12405) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-03-19 |
| Last Update Date | 2025-06-23 |