| NPI | 1205273539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 58891) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI LP02750) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CT 55683) | |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2018-09-06 |