| NPI | 1659830040 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 20A19606) |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2025-09-25 |