| NPI | 1861012148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A197652) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 338942) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2024-07-21 |