NPI | 1861874323 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R0146) |
Additional Taxonomies | 208D00000X General Practice (Licence: TX R0146) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: TX R0146) | |
207P00000X Emergency Medicine (Licence: TX R0146) | |
208D00000X General Practice (Licence: NE 1533) | |
Enumeration Date | 2015-06-22 |
Last Update Date | 2021-03-31 |