| NPI | 1891435129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 82000-21) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125.080932) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-01 |
| Last Update Date | 2025-09-10 |