| NPI | 1033521117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NE 32413) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 244202) |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2020-04-03 |