| NPI | 1912491838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T4097) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL MD.38762) |
| 207Q00000X Family Medicine (Licence: AL MD.36762) | |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2021-12-28 |