| NPI | 1407436603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4351048146) |
| Additional Taxonomies | 2080H0002X (Licence: MI 4351048146) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2024-05-20 |