| NPI | 1902218795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TN 54640) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: TN 54640) | |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2022-03-23 |