| NPI | 1457484727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TN 43767) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 27981) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TN 43767) | |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: TN 43767) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2012-09-12 |