| NPI | 1962851667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 11236456-1204) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM R-07-2016MNT) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2020-08-10 |