| NPI | 1396107512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX U5135) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX U5135) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL J535-731-89-447-0) | |
| Enumeration Date | 2016-03-26 |
| Last Update Date | 2024-01-25 |