| NPI | 1104388750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01089703A) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 01089703A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2026-08-17 |