| NPI | 1356756175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: IA DO-05504) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 3194) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO4290) | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2020-06-17 |