| NPI | 1457989642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116040255) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2021019731) |
| 208D00000X General Practice (Licence: MO 2019027169) | |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2025-07-02 |