| NPI | 1184904955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11017755A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R72521) |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2014-06-14 |