| 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 |