| NPI | 1821592254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ID M-15642) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL TRN27183) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN27183) | |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2021-06-24 |