| NPI | 1639524135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX s2099) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX S2099) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2023-07-06 |