| NPI | 1538486188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX R0512) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A123596) |
| 2080P0205X Pediatrics, Pediatric Endocrinology (Licence: LA 303174) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-22 |
| Last Update Date | 2022-02-23 |