| NPI | 1235427030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R8063) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2015-01941) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2020-01-16 |