| NPI | 1235666553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX U4020) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX U4020) |
| 208D00000X General Practice (Licence: TN 0000062026) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2024-04-29 |