| NPI | 1881259075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A186186) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: CA A186186) | |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2025-08-26 |