| NPI | 1033552815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 080466) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101260435) |
| 207Q00000X Family Medicine (Licence: TX T6113) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2025-03-14 |