| NPI | 1609339480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D0100826) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA11514500) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2024-09-30 |