| NPI | 1740817618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301517582) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: IL 125.075530) | |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2026-08-20 |