| NPI | 1780145185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0208X Pediatrics, Pediatric Infectious Diseases (Licence: CA A184815) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.247587) |
| 208000000X Pediatrics (Licence: OH 35.143918) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2023-04-26 |