| NPI | 1457857971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA OS022083) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: PA 05022083) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2025-06-12 |