NPI | 1023471521 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: NC 2022-02211) |
Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 35.136209) |
208000000X Pediatrics (Licence: OH 35.136209) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-04-01 |
Last Update Date | 2024-03-05 |