| NPI | 1740675800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 285768) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 291643) |
| 208000000X Pediatrics (Licence: CT 66708) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-05 |
| Last Update Date | 2022-07-26 |