| NPI | 1710249867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P8433) |
| 207P00000X Emergency Medicine (Licence: TX P8433) | |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2015-04-10 |