| NPI | 1699114553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: WA MD60898911) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD60898911) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT204291) | |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2019-08-12 |