| NPI | 1417717158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10090258) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX W0900) |
| Enumeration Date | 2024-03-20 |
| Last Update Date | 2026-03-19 |