| NPI | 1790948164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL OS12714) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 34010306) | |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2015-11-18 |