| NPI | 1982268041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA OS022182) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 58.031082) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2022-08-15 |