| NPI | 1851911051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: PA MD482634) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: PA MD482634) | |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2026-04-03 |