| NPI | 1760746531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 94186) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 01075278A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2023-02-15 |