| NPI | 1841797529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S4269) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 28552) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10063789) | |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2023-03-27 |