| NPI | 1730666801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX BP10080685) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15568) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-07-23 |
| Last Update Date | 2022-09-02 |