NPI | 1417480062 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: LA 342646) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM MD2020-0348) |
Enumeration Date | 2017-04-10 |
Last Update Date | 2024-08-05 |