| NPI | 1730820911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.153306) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2025-05-15 |