| NPI | 1336402254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q8339) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 25260) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2022-10-05 |