| NPI | 1285297747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 186873) |
| Additional Taxonomies | 2080P0205X Pediatrics, Pediatric Endocrinology (Licence: CT 71875) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2025-01-24 |