| NPI | 1104389113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CA A178457) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A178457) |
| 208000000X Pediatrics (Licence: OH 57.24806) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2023-03-23 |