| NPI | 1558732321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S6693) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 12-239) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2020-09-21 |