| NPI | 1073909396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics Pediatric Critical Care Medicine (Licence: TN 57986) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 57986) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2022-03-29 |