| NPI | 1669937033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 13302649-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101271351) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-02-09 |
| Last Update Date | 2023-06-16 |