| NPI | 1174755466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX R0417) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: AL MD. 32451) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: LA MD. 204867) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2021-08-09 |