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 |