| NPI | 1912130741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: KY 44693) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 44693) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 44693) | |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2014-08-20 |