| NPI | 1548651094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-17572) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: ID YC356923G) |
| 207Q00000X Family Medicine (Licence: TX T9288) | |
| 207R00000X Internal Medicine (Licence: TX T9288) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-02-05 |
| Last Update Date | 2024-04-10 |