| NPI | 1801062658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: SC 33464) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: SC TL33464) | |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2021-11-12 |