NPI | 1851929517 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: AL MD.47214) |
Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: AL MD.47214) |
208000000X Pediatrics (Licence: AL L.5235R) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2020-03-30 |
Last Update Date | 2024-06-14 |