| NPI | 1376925230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD465267) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT208436) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: PA MD465267) | |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2021-02-22 |