| NPI | 1194221895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2022014790) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX T1546) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10063001) | |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2022-07-22 |