| NPI | 1265099105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: KY 05734) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP20076182) |
| 207Q00000X Family Medicine (Licence: TX BP10071614) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-27 |
| Last Update Date | 2024-05-31 |