| NPI | 1790136927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL 139864) |
| Additional Taxonomies | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: FL 139864) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN23581) | |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2021-05-12 |