| NPI | 1568626646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N2442) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP1-0030935) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TX N4224) | |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2013-05-20 |