| NPI | 1174705818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301102168) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01065869A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2016-10-26 |