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 |