| NPI | 1568048387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 328005) |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2024-05-03 |