| NPI | 1407616105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10090256) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX W0153) |
| Enumeration Date | 2024-03-20 |
| Last Update Date | 2026-03-19 |