| NPI | 1285298984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX T9271) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10066998) |
| Enumeration Date | 2019-04-28 |
| Last Update Date | 2025-05-09 |