| NPI | 1346504941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 56881) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101253331) |
| 208000000X Pediatrics (Licence: FL ME119697) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 14868) | |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2023-09-19 |