| NPI | 1790367373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 13819074-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX U2201) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-23 |
| Last Update Date | 2024-05-16 |