| NPI | 1568967677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MT MED-PHYS-LIC-104492) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0102205833) |
| 208M00000X Hospitalist (Licence: VA 0102205833) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2022-05-01 |