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 |