| NPI | 1184070864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R8341) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10056158) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2025-07-08 |