| NPI | 1710113998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: MS 23809) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301094415) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301094415) | |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2015-09-10 |