| NPI | 1073958120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: SC 39233) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 39233) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2020-12-14 |