| NPI | 1972235885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL OS22199) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO8650) |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2025-05-13 |