| NPI | 1659714145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX Q7688) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10045874) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2020-11-02 |