| NPI | 1306306956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD476618) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT217898) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2022-07-28 |