| NPI | 1265663322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MT MED-PHYS-LIC-26827) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 52964) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2022-02-21 |