| NPI | 1902148919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.144038) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 62280) |
| 208000000X Pediatrics (Licence: MI EMC0002365) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-18 |
| Last Update Date | 2023-11-03 |