| NPI | 1154062560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02008327A) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OK 8039) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2025-05-15 |