| NPI | 1508252594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 60149) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 60149) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2022-04-15 |