| NPI | 1740711217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2021013354) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: KY 04801) | |
| Enumeration Date | 2017-03-25 |
| Last Update Date | 2021-07-26 |