| NPI | 1326481664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R0926) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 304225) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2017-03-31 |