| NPI | 1811570930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U6942) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10076275) |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2024-06-01 |