| NPI | 1558045831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10086144) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10086144) |
| 171000000X Military Health Care Provider (Licence: TX BP10086144) | |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2023-06-14 |