| NPI | 1912183591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NM MD2014-0728) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: AZ 40238) | |
| 208000000X Pediatrics (Licence: TX Q2038) | |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2015-12-08 |