| NPI | 1720424831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T0074) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP1-0046042) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2021-09-30 |