| NPI | 1477135796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: HI MD-22938) |
| Additional Taxonomies | 208D00000X General Practice (Licence: HI MD-22938) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: HI MD-22938) | |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2024-08-23 |