| NPI | 1942879747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 74956) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN33946) |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2026-01-14 |