| NPI | 1790148666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA 61256349) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 10505892-1205) |
| 208000000X Pediatrics (Licence: OH 35.135534) | |
| 2080P0203X Pediatrics Pediatric Critical Care Medicine (Licence: AZ 71591) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2024-04-29 |