| NPI | 1861195133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX V3402) |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2024-10-29 |