| NPI | 1912403122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NM MD2026-0020) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101271753) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2026-03-02 |