| NPI | 1982199162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A174254) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 1982199162) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2021-08-03 |