| NPI | 1902366818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2022-01731) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NC 2022-01731) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 2022-01731) | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2023-12-18 |