| NPI | 1932632163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: OH 35.140274) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.140274) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2025-04-22 |