| NPI | 1790948404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WA MD600454731) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT193623) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT193623) | |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2024-07-30 |