| NPI | 1356784029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: SC 84174) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 48701) |
| 208000000X Pediatrics (Licence: OH 130552) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2020-10-26 |