| NPI | 1417335571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S3736) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10057234) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-09 |
| Last Update Date | 2020-07-14 |