| NPI | 1831784438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101276554) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101276554) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-04 |
| Last Update Date | 2024-05-16 |