| 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 |