| NPI | 1972172567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 6255) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125.079723) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2025-06-12 |