| NPI | 1205152634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: UT 8577079-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 8577079-1205) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-09 |
| Last Update Date | 2021-12-03 |