| NPI | 1164952305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 99129) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 02005564A) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 02005564A) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2024-09-17 |