| NPI | 1386024164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT217869) |
| Additional Taxonomies | 207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: IL 036146672) |
| 208000000X Pediatrics (Licence: IL 125066842) | |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2019-06-17 |