| NPI | 1578724555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: NV 15904) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: OH 35.097064) | |
| 208000000X Pediatrics (Licence: GA 067558) | |
| Enumeration Date | 2008-06-22 |
| Last Update Date | 2015-07-07 |