| NPI | 1316461536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics Pediatric Critical Care Medicine (Licence: VA 0101281683) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2017-07-29 |
| Last Update Date | 2024-08-23 |