| NPI | 1770052599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME162837) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY p10584) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-11-21 |
| Last Update Date | 2023-09-22 |