| NPI | 1649962572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10085777) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2025-01-10 |