| NPI | 1053844803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 59187) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL TRN26993) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: KY TP991) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-08 |
| Last Update Date | 2024-06-05 |