| NPI | 1619544129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV 25963) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SD 16744) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-04 |
| Last Update Date | 2025-02-25 |