| NPI | 1285122762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 109444) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: MA 290390) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MA 290390) | |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2026-06-04 |