| NPI | 1487032488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0216X Pediatrics, Pediatric Rheumatology (Licence: CT 68777) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD465877) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2021-07-02 |