| NPI | 1710418884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: CT FG8950621) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2080S0010X Pediatrics, Sports Medicine (Licence: NY 301291) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2021-11-18 |