| NPI | 1720738230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A191164) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA PTL10347) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-27 |
| Last Update Date | 2023-10-02 |