| NPI | 1992192066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MB10433700) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 146013200) |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2019-02-28 |