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 |