| NPI | 1548755309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: FL ME151386) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME151386) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN27073) | |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2024-07-31 |