| NPI | 1912388323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA L-262980) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2016-05-31 |