| NPI | 1366939795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX T7331) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 75525) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2022-12-19 |