| NPI | 1205213980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS ET-00355) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 56399) |
| 207P00000X Emergency Medicine (Licence: CA A154017) | |
| 207Q00000X Family Medicine (Licence: WA MD60833909) | |
| 207Q00000X Family Medicine (Licence: CA A154017) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2022-10-03 |