| NPI | 1477295749 |
|---|---|
| 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: NY 335612) |
| Enumeration Date | 2022-04-08 |
| Last Update Date | 2026-07-22 |