| NPI | 1518354521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R9518) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 21091) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2024-03-19 |