| NPI | 1003108614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: FL ME132167) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX P9568) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX P9568) | |
| Enumeration Date | 2011-05-15 |
| Last Update Date | 2020-10-26 |