| NPI | 1396003802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 52703) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 52703) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2021-09-29 |