| NPI | 1043899834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V0874) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2023028648) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2024-09-20 |