| 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 |