| NPI | 1629509302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME160857) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.03227) |
| 208000000X Pediatrics (Licence: OH 35139206) | |
| 208000000X Pediatrics (Licence: FL ME160857) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 35139206) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2023-06-29 |