| NPI | 1073074936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX T6905) |
| 2080P0206X Pediatrics, Pediatric Gastroenterology (Licence: TX T6905) | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2025-06-10 |