| NPI | 1144480815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S8437) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2015-01575) |
| 208D00000X General Practice (Licence: NE 25380) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2022-02-10 |