| NPI | 1699330928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.144897) |
| Additional Taxonomies | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: OH 35.144897) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 250517) | |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2024-09-23 |