| NPI | 1881711216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: KY 43318) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: PA MD447401) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2014-07-24 |