NPI | 1235698127 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CT 082343) |
Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD477752) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 082343) | |
Enumeration Date | 2019-03-19 |
Last Update Date | 2025-07-25 |