| NPI | 1770088619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL OS17478) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO6029) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2024-06-06 |