| NPI | 1992025084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: WV 24777) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 24777) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2016-09-02 |