| NPI | 1770167181 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V2771) | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program | 
| 207Q00000X Family Medicine (Licence: OK 7843) | |
| Enumeration Date | 2021-05-11 | 
| Last Update Date | 2025-03-11 |