| NPI | 1316333446 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NY 298763)  | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 274395)  | 
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: NY 298763)  | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MA 274395)  | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-15 | 
| Last Update Date | 2023-06-06 |