| NPI | 1720321789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: TX Q4651) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX Q4651) |
| 208000000X Pediatrics (Licence: TX Q4651) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2022-12-01 |