| NPI | 1184919110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D91255) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q1045) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 172869) | |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2022-02-24 |