| NPI | 1902433014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 12404077-1205) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2023-06-22 |