| NPI | 1104054212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q2444) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101250355) |
| 207Q00000X Family Medicine (Licence: MD D0074239) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2019-04-20 |