| NPI | 1497956734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N3996) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101244085) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2025-07-02 |