| NPI | 1053608281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 47334) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: KY 47334) | |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2016-06-01 |