| NPI | 1851453856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P4795) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME95916) |
| 207Q00000X Family Medicine (Licence: LA MD201936) | |
| 207Q00000X Family Medicine (Licence: GA 65485) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 563769) | |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2016-11-01 |