| NPI | 1447712278 |
|---|---|
| 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: NM MD2022-0924) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2024-01-05 |