| NPI | 1053575142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NM MD2012-0113) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10031735) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2022-10-03 |