| NPI | 1376162693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI 23711) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T3309) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX T3309) | |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2023-08-03 |