| NPI | 1205398112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080C0008X Pediatrics, Child Abuse Pediatrics (Licence: WI 77553-20) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WI 77553-20) | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2025-08-06 |