| NPI | 1942706858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0102207137) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125072096) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2022-06-10 |