NPI | 1770014052 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: FL ME146189) |
Additional Taxonomies | 208000000X Pediatrics (Licence: FL 146189) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-03-27 |
Last Update Date | 2023-11-01 |