| NPI | 1588015705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL OS15996) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO5178) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2021-03-11 |