| NPI | 1962068031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.149923) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT222325) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2024-08-08 |