| NPI | 1922340330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NY 304887) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VT 042.0013399) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: PA MT212624) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-24 |
| Last Update Date | 2023-07-03 |