| NPI | 1629456629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA11044100) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NJ 25MA11044100) | |
| 208000000X Pediatrics (Licence: OH 35.133449) | |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2024-04-09 |