| NPI | 1134575384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 7515993-1204) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 007582) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207Q00000X Family Medicine (Licence: AZ 007582) | |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2026-04-13 |