| NPI | 1952574626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R7202) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA DO.000188) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2023-07-24 |