| NPI | 1609442672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA ML61548659) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 38270) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-01 |
| Last Update Date | 2024-06-29 |