| NPI | 1720585219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IA MD-49988) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 72740-20) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2022-08-28 |