| NPI | 1811371263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WA MD60858535) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101277363) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: HI MDR 6935) | |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2024-05-28 |