| NPI | 1265606735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 8644418-1204) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: VA 0102203101) | |
| 208000000X Pediatrics (Licence: UT 8644418-1204) | |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2016-12-18 |