| NPI | 1366974461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 88862) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.139244) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2021-07-01 |