| NPI | 1184890543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N8336) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 43275) |
| 207Q00000X Family Medicine (Licence: WA MD 60036832) | |
| 207Q00000X Family Medicine (Licence: UT 7333423-1205) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA ML 20009169) | |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2016-07-12 |