| NPI | 1215509054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01096718A) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY P110445) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2026-01-08 |