| NPI | 1205003605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: LA MD 205253) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA MD.205253) |
| 208000000X Pediatrics (Licence: GA 002019) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101247049) | |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2023-06-13 |