| NPI | 1154764017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NY 208088) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD457144) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2020-04-28 |