| NPI | 1902455504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2022030304) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4351045516) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2022-08-16 |