| NPI | 1790196616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S8262) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-9952) |
| 207Q00000X Family Medicine (Licence: LA 305934) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AR E-9952) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2022-07-21 |