| NPI | 1992237200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.148950) |
| Additional Taxonomies | 2080P0216X Pediatrics, Pediatric Rheumatology (Licence: OH 35.148950) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2023-11-07 |