| NPI | 1558519413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WV 25107) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: MN 54549) | |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2022-04-08 |