| NPI | 1821663824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: RI MD19779) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI LP05253) |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2024-04-26 |