| NPI | 1386062503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM MD2023-0285) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD60758073) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2025-04-02 |