| NPI | 1194178319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: TX U5001) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 66852) |
| 207Q00000X Family Medicine (Licence: TX U5001) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-07-22 |
| Last Update Date | 2023-09-08 |