| NPI | 1518498054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AL 42434) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME143517) |
| 208000000X Pediatrics (Licence: MS T-3420) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-26 |
| Last Update Date | 2022-02-22 |