| NPI | 1194213678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A180921) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: VA 0101271644) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: VA 0101271644) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208000000X Pediatrics (Licence: VA 0101271644) | |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2022-08-03 |