| NPI | 1003228545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X (Licence: IN 01082152A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11017627A) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2020-11-16 |