| NPI | 1548616170 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S0761) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10057107) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2019-08-30 |