| NPI | 1831706985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN32024) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL TRN32024) |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2021-07-12 |