NPI | 1386214922 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: TX U7264) |
Additional Taxonomies | 171000000X Military Health Care Provider |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2021-06-27 |
Last Update Date | 2023-11-30 |