| NPI | 1518429984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DC MD210002181) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN36745) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2026-06-30 |