| NPI | 1023275773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N1601) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: DC MD041502) | |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2013-07-30 |