| NPI | 1720202625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P4316) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: MN 50841) | |
| 207SG0201X Medical Genetics, Clinical Genetics (M.D.) (Licence: TX P4316) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2013-03-01 |