| NPI | 1598917510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P0538) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX TMBPIT#BP10032305) |
| 208600000X Surgery (Licence: TX P0538) | |
| Enumeration Date | 2008-10-22 |
| Last Update Date | 2012-07-09 |