| NPI | 1326569286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO5743) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036-153717) |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2026-03-03 |