| NPI | 1497134696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R8461) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-11579) |
| 207Q00000X Family Medicine (Licence: WA MD61131539) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2023-11-02 |