| NPI | 1740970490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: RI LP05921) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI LP05921) |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2023-06-23 |