| NPI | 1740928514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX W1223) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TX W1223) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NH R4045) | |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2025-09-23 |