| NPI | 1295112159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD463351) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 01098741A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2026-05-21 |