| NPI | 1619552908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101276748) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101276748) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-17 |
| Last Update Date | 2024-07-23 |