| NPI | 1558779330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME132605) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA PGY.202402) |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2018-10-01 |