| NPI | 1457840662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: NY 331217) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 88712) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2025-03-26 |