| NPI | 1013409317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 010397) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T3832) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2023-03-19 |