| NPI | 1821592536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 12809) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: MS T-3557) | |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2021-06-18 |