| NPI | 1043744824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2020-0387) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10060979) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2024-04-11 |