| NPI | 1336594662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 294454) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 64258) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MA 294454) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-23 |
| Last Update Date | 2022-08-23 |