| NPI | 1780372375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 14246415-1204) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10085219) |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2025-10-29 |