| NPI | 1306239298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: RI MD18481) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 289031) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-17 |
| Last Update Date | 2022-06-01 |