| NPI | 1336701846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: OK 44776) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 44776) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2025-08-01 |