| NPI | 1174197438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301510124) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: MI 4301510124) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301510124) | |
| 208D00000X General Practice (Licence: OH 35.147097) | |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2026-01-29 |