| 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 |