| NPI | 1811342595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 292464) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A168177) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2022-06-07 |