NPI | 1366079634 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 168902) |
Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME162528) |
Enumeration Date | 2020-03-25 |
Last Update Date | 2024-06-03 |