| NPI | 1053989210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T9892) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10076089) |
| 207Q00000X Family Medicine (Licence: TX T9892) | |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2024-07-02 |