| NPI | 1194349597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX U2286) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10071557) |
| 207Q00000X Family Medicine (Licence: TX U2286) | |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2024-01-24 |