| NPI | 1952806077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 105015) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35.137606) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2025-08-11 |