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 |