NPI | 1043579501 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: CA 20A12992) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2012-05-03 |
Last Update Date | 2018-07-01 |