| NPI | 1447541693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX Q2916) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 173024) |
| Enumeration Date | 2011-04-22 |
| Last Update Date | 2021-04-28 |