| NPI | 1659791572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S8500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A142563) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2022-06-09 |