| NPI | 1508076753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 7540742-1204) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R1030) |
| 207Q00000X Family Medicine (Licence: AZ 5166) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2016-09-28 |