| NPI | 1528448602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61178592) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R2472) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10054277) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2021-09-22 |