| NPI | 1104405612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: IN 01096739A) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301514707) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351049056) | |
| Enumeration Date | 2021-04-03 |
| Last Update Date | 2025-07-30 |