NPI | 1700442407 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U8192) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 3646) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-05-17 |
Last Update Date | 2024-06-28 |