NPI | 1548617079 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: CT 68887) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NY 297880) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-05-13 |
Last Update Date | 2023-09-27 |