| NPI | 1093452468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS21806) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10080329) |
| 207Q00000X Family Medicine (Licence: TX U7411) | |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2026-03-09 |