| NPI | 1972990174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 11929964-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R0578) |
| 207Q00000X Family Medicine (Licence: OR MD189449) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-25 |
| Last Update Date | 2024-07-30 |