| NPI | 1275854713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NE 28891) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2011033546) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2010017403) | |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2019-09-20 |