| NPI | 1093277881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: CT 73313) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MS 91631) |
| 208000000X Pediatrics (Licence: MS T-3788) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208000000X Pediatrics (Licence: FL 154381) | |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2023-08-10 |