| NPI | 1629270798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: FL ME108862) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL trn8108) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MA 235075) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2012-02-13 |