| NPI | 1679993034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX R4092) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX 45997) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 582589) | |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2018-02-23 |