| NPI | 1831369222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX T4037) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 58070) |
| 208D00000X General Practice (Licence: CA 20118) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2024-03-24 |