| NPI | 1164837241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: KS 0442734) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD461387) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2020-02-26 |