| NPI | 1659876332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NH 22957) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VT 042.0015364) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2022-08-12 |