| NPI | 1548798630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61516797) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC MD83739) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2024-06-28 |