NPI | 1528647955 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: FL OS22316) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NY 332962-01) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2021-04-04 |
Last Update Date | 2025-07-16 |