| 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 |