| NPI | 1346539004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: SC 39919) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL OS12748) |
| 208000000X Pediatrics (Licence: SC 39919) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2021-06-08 |