| NPI | 1003202128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2024-0278) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA GETP.201540) |
| 207Q00000X Family Medicine (Licence: TX s4829) | |
| 208M00000X Hospitalist (Licence: TX s4829) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2024-09-19 |