| NPI | 1760861116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R0694) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10054192) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10054192) | |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2022-11-21 |