| NPI | 1154556496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MA 251391) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 241002) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208000000X Pediatrics (Licence: AZ 47543) | |
| Enumeration Date | 2009-05-15 |
| Last Update Date | 2016-06-07 |