| NPI | 1902251770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101272529) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 82764) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2021-07-19 |