| NPI | 1245490424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: UT 7891781-1205) |
| Additional Taxonomies | 282NC2000X General Acute Care Hospital, Children |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2021-12-10 |