| NPI | 1386064285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 10493833-1204) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 98-08403) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-18 |
| Last Update Date | 2025-05-09 |