| NPI | 1003047952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX T8758) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME138925) |
| 207P00000X Emergency Medicine (Licence: ND 12327) | |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: TX T8758) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN13760) | |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2023-07-17 |