| NPI | 1598109480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX R5796) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA no license yet) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA no license yet) | |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2019-10-25 |