| NPI | 1811393937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX R3697) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 282NC2000X) |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2022-07-21 |