| NPI | 1578950945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S6741) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 18547) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2024-09-20 |