NPI | 1558998401 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: CT 78832) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
208000000X Pediatrics (Licence: NY 323086) | |
Enumeration Date | 2020-03-23 |
Last Update Date | 2024-07-01 |