| NPI | 1487158895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX S9959) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX S9959) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2022-05-26 |