| NPI | 1194258863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME144762) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA11130400) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-09 |
| Last Update Date | 2024-02-27 |