| NPI | 1033848858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V3688) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME169766) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10081423) | |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2024-09-11 |