| NPI | 1538319827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA08656900) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 249516) |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2018-09-25 |