| NPI | 1649626524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2020020178) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: NY 298117-1) | |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2020-10-01 |