| NPI | 1760771133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: KY 46862) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 46862) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 46862) | |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2024-07-24 |