| NPI | 1780979435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX Q0177) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: TX Q0177) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2022-07-21 |