| NPI | 1255643029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: WI 56555) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 56246) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2017-01-10 |