| NPI | 1780264317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U2350) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TX U2350) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2025-08-25 |