| NPI | 1992207435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA OP61532252) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 2088) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-01 |
| Last Update Date | 2024-04-19 |