| NPI | 1255751657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MA 274256) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 274256) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL F65597787083) | |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2021-05-13 |