| NPI | 1902433014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: ID 1971297) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: UT 12404077-1205) | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2026-03-13 |