| NPI | 1083155337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-14988) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 10939737-1205) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-19 |
| Last Update Date | 2020-12-02 |