| NPI | 1114668571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX V3000) |
| 207Q00000X Family Medicine (Licence: CA A199781) | |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2024-11-01 |