| NPI | 1013103449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN md46326) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: MS 25428) | |
| 207Q00000X Family Medicine (Licence: AR E-13987) | |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2023-01-30 |