| NPI | 1134509110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI LP03510) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2018-05-31 |