| NPI | 1164717401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q0748) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-8031) |
| 207Q00000X Family Medicine (Licence: CA A128975) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2026-09-01 |