| NPI | 1881115442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T3436) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS16885) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL OU5757) | |
| Enumeration Date | 2017-07-04 |
| Last Update Date | 2022-01-04 |