| NPI | 1366827446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: MS 29685) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: KY 55297) | |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2025-09-09 |