| NPI | 1639583982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: TX R3953) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11017775A) |
| 208000000X Pediatrics (Licence: TX R3953) | |
| Enumeration Date | 2014-06-15 |
| Last Update Date | 2022-06-10 |