| NPI | 1407551682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 208600) |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2026-04-09 |