| NPI | 1861913501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: FL ME169959) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 21450) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2024-10-11 |