| NPI | 1386132330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T5174) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35140120) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2022-10-13 |