| NPI | 1649561614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CT 53423) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 53423) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2023-09-12 |