| NPI | 1346944261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 12194) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 3019851) |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2026-03-30 |