| NPI | 1194427815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 14155775-1204) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: UT 14155775-1204) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-03-17 |
| Last Update Date | 2026-02-04 |