| NPI | 1013368059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA10935600) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD468006) |
| 208000000X Pediatrics (Licence: PA MD468006) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2025-02-25 |