| NPI | 1558392134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME120649) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q1206) |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9102608) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10040024) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2020-04-29 |