| NPI | 1821325994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WV 24868) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WV 24868) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-11-11 |
| Last Update Date | 2022-04-15 |