| NPI | 1477176451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 74384) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA OT019843) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-05-25 |
| Last Update Date | 2024-08-23 |