| NPI | 1851965354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM MD2024-0479) |
| 208000000X Pediatrics (Licence: SC LL86134) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2025-06-13 |