| NPI | 1831689371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 74805) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151010470) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101025570) | |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2021-07-04 |