| NPI | 1356934038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: PA OT023381) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 2686) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-02-14 |
| Last Update Date | 2024-05-26 |