| NPI | 1649662073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD219244) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA ML60864368) |
| 2080C0008X Pediatrics, Child Abuse Pediatrics (Licence: OR MD219244) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2026-07-15 |