| NPI | 1346612157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S8697) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19210) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NE 7964) | |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2020-11-20 |