| NPI | 1720473440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NE 1602) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 1602) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MD H0094946) | |
| 208D00000X General Practice (Licence: NE 1602) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2022-10-07 |