| NPI | 1295935716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: TX R5670) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101243986) |
| 208000000X Pediatrics (Licence: TX R5670) | |
| 208D00000X General Practice (Licence: VA 0101243986) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2018-12-14 |