| NPI | 1508507930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AR E-19388) |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2025-08-07 |