| NPI | 1689106486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T1494) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA a157391) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2021-08-16 |