| NPI | 1407067903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 7682326-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R1034) |
| 207Q00000X Family Medicine (Licence: TX NONE) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R1034) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2022-07-21 |