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 |