| NPI | 1750748257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: TX R4633) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX R4633) |
| 208D00000X General Practice (Licence: TX R4633) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX R4633) | |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2022-07-19 |