| NPI | 1972957942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX R9411) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R9411) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2023-05-03 |