| NPI | 1366007866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 58025) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 58025) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2023-07-10 |