| NPI | 1992371769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 320456) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: HI 1992371769) | |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2026-10-23 |