| NPI | 1750762381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S0471) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT209579) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2020-07-01 |