| NPI | 1639604069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S6963) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: TX S6963) | |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2021-12-21 |