| NPI | 1376800821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 261718) |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2022-09-09 |