| NPI | 1629486618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A171569) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD-458870) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2022-01-12 |