| NPI | 1720630957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0205X Pediatrics, Pediatric Endocrinology (Licence: TX T8075) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX T8075) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2025-07-30 |