| NPI | 1992443683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX V8394) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10079298) |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2025-08-01 |