| NPI | 1144617358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS019637) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q9708) |
| 208D00000X General Practice (Licence: TX Q9708) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 592181) | |
| Enumeration Date | 2015-04-26 |
| Last Update Date | 2024-06-11 |