NPI | 1548755309 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME151386) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN27073) |
Enumeration Date | 2018-06-25 |
Last Update Date | 2023-01-12 |