| NPI | 1861811101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: FL ME133054) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: MA 274448) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2021-08-17 |