| NPI | 1629457965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: PA MT217300) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 57270) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TN 57270) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2019-06-25 |