| NPI | 1649632225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 82346) |
| Additional Taxonomies | 2080P0208X Pediatrics, Pediatric Infectious Diseases (Licence: GA 82346) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2026-05-12 |