| NPI | 1396321071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: RI MD20702) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: MA 1018685) | |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2025-07-16 |