| NPI | 1578067955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME149451) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL TRN26245) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2023-11-13 |