| NPI | 1992237515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2023-00579) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 60998) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-02 |
| Last Update Date | 2023-07-14 |