| NPI | 1164803375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX S6061) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ R2500) |
| 208000000X Pediatrics (Licence: AZ 007585) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10066150) | |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2021-05-16 |