| NPI | 1942756143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A169322) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: DE C70006424) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2020-10-07 |