| NPI | 1346933777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10085891) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX V3598) |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2024-10-01 |