| 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 |