| NPI | 1356966055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC RTL22-1096) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT220165) |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2022-08-24 |