| NPI | 1679991194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics Pediatric Critical Care Medicine (Licence: FL ME133949) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 0) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2023-04-27 |