| NPI | 1508009135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME117064) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q1570) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2020-06-11 |