| NPI | 1962778878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX Q2978) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX Q2978) |
| Enumeration Date | 2012-03-25 |
| Last Update Date | 2025-06-30 |