| NPI | 1659993855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0214X Pediatrics, Pediatric Pulmonology (Licence: CT 78193) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 341600) |
| 2080P0214X Pediatrics, Pediatric Pulmonology (Licence: NY 341600) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2026-01-14 |