| NPI | 1366124893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351051275) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A207105) |
| Enumeration Date | 2023-08-03 |
| Last Update Date | 2026-03-10 |