| NPI | 1255063582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME181442) |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2026-07-27 |