| NPI | 1003312869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: VA 0101272170) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101272170) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: VA 0101272170) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2021-07-12 |