| NPI | 1982299350 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NE 35244) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 35244) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-07 |
| Last Update Date | 2024-11-06 |