| NPI | 1952534844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P7802) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 036131128) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 57543-20) | |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2023-03-16 |