| NPI | 1194105320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: HI DOS-1819) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: HI DOS-1819) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2021-12-21 |