| NPI | 1639860638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351050699) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO DR.0077339) |
| Enumeration Date | 2023-05-19 |
| Last Update Date | 2026-04-25 |