| NPI | 1467637819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX m9898) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ 80882) |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2012-05-14 |