| NPI | 1962864637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX T6380) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.028432) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2022-06-29 |