| 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 |