NPI | 1972178333 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U1479) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX U1479) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10075195) | |
Enumeration Date | 2021-05-26 |
Last Update Date | 2023-12-20 |