| NPI | 1871948141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10078269) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101264385) |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2022-05-10 |