| NPI | 1710383187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: CA 20A14267) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 20A14267) |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: NV DO2907) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-11-13 |
| Last Update Date | 2023-01-31 |